Download Chapter 6 Sterile Product Preparations

Sterile Products and Aseptic Techniques
for the Pharmacy Technician
CHAPTER
6
Sterile Product
Preparations
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
IV Bags
• Most common sterile product
• Contain base solutions + medication
• Medication must be diluted before
administration
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
IV Bags (cont’d)
• Two types
– Intravenous piggybacks
– Continuous preparations
 Large-volume IVs
 Drips
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
IV Bags (cont’d)
IV Piggybacks (IVPB)
• Also known as small-volume parenterals
(SVP)
• Administered over short time at specific
intervals
• Consist of base fluid (D5W or NS) &
medication
• Range in volume from 25 to 250 mL
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
IV Bags (cont’d)
• Used when
– Patient cannot take another method
– Medication needs to act quickly
• Typically are antibiotic, antifungal,
antiviral, mineral replacement, or
maintenance medicine
• Add-A-Vial/Advantage systems
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
IV Piggyback
FIGURE 6-2 Intravenous piggyback
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
IV Bags (cont’d)
Continuous Preparations
• Large-volume IVs (LVIV)
–
–
–
–
–
–
Also known as large-volume parenteral (LVP)
Infused on a continuous rate
For hydration & electrolyte/vitamin replacement
500 mL or greater (most common = 1 liter)
Many consist of just base solution, no additive
Also for continuous antibiotic infusions
(infections)
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
IV Bags (cont’d)
Continuous Preparations
• Drips
– Infused at very slow rate
– For nitroglycerin, insulin, amiodarone,
lidocaine, nitroprusside, heparin, narcotics
– 500 mL or less
– Ordered by amount of drug to be infused over
given timeframe (mg/kg/min or mcg/hr)
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Syringes
• Used for IV push (IVP)
• Undiluted IVP medications
– Skin tests
– Vaccinations
– Colony-stimulating factors
• Diluted IVP medications
– Personal controlled analgesia (PCA)
– Pediatric & neonatal antibiotics
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Multi-Dose Vials (MDVS)
• Can be used multiple times, for multiple
doses
• Can retain sterility after >1 needle
puncture
• Usually contain preservatives
• Remainder in vial must be
– Stored properly
– Used before expiration date
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Multi-Dose Vials (MDVS) (cont’d)
• Tech must label date/time opened, initials
on vial
• Expiration date is 28 days, if not specified
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Patient-Controlled Analgesia
• An IV pain medication
• Patient controls delivery of drug
• When patient has pain, he/she pushes
button
• Administered via various IV pumps &
devices
• Devices are calibrated to prevent
overdose
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Patient-Controlled Analgesia
(cont’d)
FIGURE 6-7 Patient-controlled anesthesia
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Epidurals
• Inserted intrathecally
• For pain control in surgery or obstetrics
• Consist of anesthetic, alone or with a
narcotic
• Common anesthetics: bupivacaine,
ropivacaine
• All medication must be preservative-free
• Preservatives in epidurals can cause
paralysis
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Neonates and Pediatric Patients
• Typically require dilutions
• Dilutions
– Make substances less concentrated
– Used when dose is too small to be measured
accurately
 Example: 5 unit insulin dose diluted to 0.5 mL
– Are less taxing on developing liver & kidneys
– Common dilution medications: antibiotics,
antifungals, antivirals, narcotics, insulin
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Irrigations
• Used in surgery to irrigate open surgical
sites
• Must be sterile, though not administered
by IV
• Most common irrigations
– Surgical antibiotic solution (SAS)
– Gentamicin irrigation solution
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Irrigations (cont’d)
• Sterile water & normal saline used for
irrigations must be labeled “for irrigation
only”
• Do not meet requirements for IV use
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Cytotoxic Agents
• Chemotherapy drugs
• Always compounded in biological safety
cabinet
• Vertical airflow of BSC prevents aerosols
from being blown toward technician
• Come in various forms
– Syringes
– IVPBs
– Continuous infusions
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Total Parenteral Nutrition (TPN)
• For patients unable to receive adequate
nutrition via other means
• Provide all dietary requirements to sustain
life
• Contain protein, fat, sugar, water,
minerals, electrolytes, & vitamins
• Compounded daily, every 24 hours
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Total Parenteral Nutrition (TPN)
(cont’d)
• Specific to patient’s needs & size
• IV bag size ranges from 500 to 3000 mL
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Albumin
• A sterile solution for a single-dose
administration
• Contains 25% human albumin
• Used to treat
– Hypovolemic shock (with exchange
transfusion)
– Neonatal hyperbilirubinemia
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Albumin (cont’d)
• May be a floor stock item in critical-care
areas
• Don’t use if turbid or if sediment is in bottle
• Begin administration within 4 hr after
puncturing bottle
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Plasma Protein Fraction (Ppf)
• A sterile solution for single-dose IV admin.
• Contains 5% plasma proteins
• Used to prevent & treat hypovolemic
shock
• Also used to treat severe hypoproteinuria
• Don’t use if turbid or if sediment is in bottle
• Begin administration within 4 hours after
puncturing bottle
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Immunoglobulin (Gammar-P, IgG)
• A sterile, lyophilized, single-dose
preparation of immune globulin
• Indicated for patients with
– Primary defective or suppressed immune
systems
– Greater risk for infection
• Wear chemo gloves when preparing
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Immunoglobulin (Gammar-P, IgG)
(cont’d)
• Must be reconstituted before
admininstration
• Short stability time, expensive
• Use within 24 hr of reconstitution
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Factor VIII (Alphanate)
• A sterile, lyophilized, single-dose
concentrate of antihemophilic factor (AHF)
• Used to prevent & control bleeding
• For patients with Factor VIII deficiency
• Wear gloves when preparing
• Refrigerated; must be warmed to room
temp
• Must be administered within 8 hours
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Factor IX (Konyne)
• A sterile, lyophilized, single-dose
concentrate of AHF
• For IV admin. to treat Factor IX deficiency
• Reconstitution, handling, & delivery same
as for Factor VIII
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Ophthalmics
• Must be prepared using aseptic technique
• Most preparations are available from
manufacturer
• Special strengths/formulations must be
compounded by pharmacy
• Sterilized by filtration before being
packaged in dropper bottle
Sterile Products and Aseptic Techniques for the Pharmacy Technician, Second Edition
Mike Johnston
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.